Common side effects of heart failure medication

Most medicines have unwanted effects but everyone reacts differently and not everyone is aware of side effects. Because people with heart failure take many different drugs, they may well experience unusual sensations or new feelings. Some reactions such as extreme sun-sensitivity are clearly a side effect of medication, but other feelings such as confusion or memory loss may be part of having heart failure. One or two people said they had experienced no side effects from their medication, and several recognised that it was difficult to tell the difference between symptom and side effect.

That's a difficult question to answer, because I'm on a lot of medication, I'm not sure which has got the worse side effect - they've all got awful side effects. I think the reason why my hands go dead so often is because of one particular medication, I'm not going to say which one it is because I might be wrong and I might get into a lot of trouble. I'm not sure, it's hard to separate it from my actual symptoms and condition, I don't think I can answer that very easily. I think the whole thing... the reason I get the nausea even is a mixture of both, without taking that medicine I would be in a lot of trouble, I wouldn't be able to eat my meals half the time and get the medication down me.

view profile

Profile Info

Age at interview:

57

Sex:

Female

Background:

Beth is divorced and has grown up children. She had to give up her paid job as an NHS administrator because of her health problems but now does part time voluntary work giving benefits advice to people with cancer. Ethnic background: White English.

But one of the things I have noticed is with my medication, I thought it was something getting stuck in my throat and dissolving in my throat, which is why when I was having the heart attacks I never took any notice of the discomfort because I thought it was one of my tablets had dissolved in my throat. And that goes on, happens quite regularly. It still happens. Unfortunately now I know it is cardiac related, possibly angina, so I know to use the spray now, whereas I used to always blame my tablets getting stuck in my throat or a reaction between the meds that I was taking at the same time.

So can you describe that feeling then, it’s not exactly a pain?

It's not a pain it’s more a, a discomfort. And the only way I could describe it to the hospital was as if I had swallowed bleach, as if I had swallowed a couple of capfuls of bleach and my insides were burning. And that was the pain I felt when I was having the heart attack as well. But like I said because I’d had it prior, and it always seemed to be after I was taking my medications, I thought it was one of the tablets sticking in my throat and dissolving, but unfortunately it turned out it was cardiac. And when I started getting that pain again more recently, I knew, you know, I need to speak to my doctor about this straight away. And my doctor dealt with it, you know, reassured me that it was angina pain and just to use my spray. And if it become more problematic I had to go back in and see him. Or if it didn’t, if the spray didn’t take the pain away I was to phone 999 and get an ambulance straight away.

A wide range of side effects were reported by people we spoke to, some of which caused them to stop taking a particular medicine and try another one. Some of the side effects mentioned were due to the medicines having their desired effect but too strongly. Dizziness and nausea were common after first starting to take beta-blockers, though these feelings usually stopped once people had got used to the drugs. Some felt that their heart had been slowed too far by beta blockers, making it difficult for them to do all their normal activities.

Religiously in the morning I take them. In the evening that can be up and down, but if I miss an evening then I make sure that I'll take an easy evening and take them that evening, you know what I mean?

But the water tablets, the morning ones and the heart tablets which now have been regulated now. I used to take them in the mornings but now I'm taking them in the evenings, which I think is a better thing because when you took them in the morning, well I used to have like dizzy spells if I was to bend down too quickly, I'd feel faintish. And then my GP at the hospital turned round and said, 'Well they're changing the programme and putting them on nights because obviously, you're relaxed, your sleeping.' So if your pressure goes down or whatever, you're in sleep, it's not going to kill you so you're there in sleep so not going to feel it, which is better.

Are those the beta-blockers?

The beta-blockers, yes.

Well, it's hard to pin-point because I take 4, 5 in the mornings so I've got 5 tablets working around so I don't know if it's this or that. The only one I have, well obviously the beta-blocker, when I went up from the 1mg to 2.5 and then 3.75, then it went on to 5, oh that was, you know that was when I could feel the heart, you know what I mean?

Because obviously, well the way I look at it, it's slowing it down so if I'm continuing doing what I normally do it's putting extra pressure on my heart so obviously you're going to feel it more, ain't it? Because you've one slowing it down and there's you trying to work it and it's going, hang on, what's going on here, you know. This has said slow down and you're saying you want more, you know what I mean? So, I explained that to the nurses down there and they says, 'Oh, if you feel uncomfortable just drop that down to the one that you feel comfortable with.' Like again, none of the other tablets, nobody said nothing to me about the other tablets, you know what I mean? And it doesn't seem like they're interested about the other tablets, it's just the beta-blocker and that's it.

view profile

Profile Info

Age at interview:

67

Sex:

Male

Background:

Peter is a retired university tutor and is married with grown up children. Ethnic background: White English.

I think the bisoprolol, as a beta-blocker, slows you down, depresses your activity and makes you feel knocked off, and that has affected me, probably, and I think still does but you kind of work through it, and I know, I know many people who’ve stopped taking their beta-blocker or other medication because they felt better not taking it. But you run the risk of losing the beneficial effects of the medication, which is supposed to protect you or treat you. I’ve had a bit of side-effect with ramipril. It has occasionally, it has the effect of inducing a bit of dizziness, and because my blood pressure is lower than it might be, you, the combination of the two, the beta-blocker and the ramipril, causes what they call positional hypotension, where your blood pressure has dropped and, when you get up you feel a bit light-headed if you, if you come up too quickly, that sort of thing. And of course warfarin has the inevitable side-effects of that you bleed or bruise, or both, more easily than you might otherwise do. But, apart from that, not too bad. Oh yes, aspirin. Aspirin has an has an effect on your gut, so I did have gastritis at one point, so I take a PPI medication. It’s currently lansoprazole as a, as to combat the gastric side-effects of aspirin and all the others combined, yeah.

Other side effects on the cardiovascular system included headache and cold extremities. However, one man said he experienced hot feet and had to sleep with his feet outside the bed covers or use a cold water bottle to cool them down. A young man felt that spironolactone caused him chest pain, so he was switched to eplerenone. People who were taking anti-platelet drugs or anti-coagulants to thin the blood found that they bruised easily or bled a lot from the slightest injury; some had nose bleeds (see ‘Warfarin, digoxin, aspirin and statins’).

Diuretics are intended to rid the body of excess fluid so that going to the loo is the primary effect of the medication. In the hours immediately following taking the diuretic people we spoke with had to empty their bladder repeatedly. This was inconvenient and interfered with their activities or their sleep, depending on what time of day they took the medicine. Those who took the drug in the mornings either delayed going out or had to make sure they knew where the nearest toilet was if they did go out (see ‘Beta blockers, ACE inhibitor, diuretics and aldosterone antagonists’). Some found this less of an issue after lowering the dose of their diuretic. Altering the timing of the tablets could help avoid this problem interfering with trips away from home.

Too high a dose of diuretics could make people dehydrated and several had been advised to keep their fluid intake up, despite taking diuretics, but achieving the right fluid balance could be difficult. Brian explained: “On the one hand you’re taking diuretic pills to get rid of water, on the other hand you’ve got to drink a lot of water; slight paradox there”.

Yes the diuretics, I think the Ace inhibitor does that as well doesn't it, but I'm not terribly sure, but I think it does make it dehydrate, so you have to have enough fluid, but I have diuretics and to get rid of excess fluid, so you have to take in fluid as well (laugh). So to keep the kidneys on the right track otherwise they get too dehydrated and then you can be in trouble.

Can you tell me a bit about the diuretics and how you take those?

Well I used to have two every day, two tablets, and I found that I was in a lot of constant you know trots and things and then they cut it down to one because I was getting peculiar side effects and dizziness, and I'd had more kidney blood tests done, and there was an area where the graft didn't show the right figures it should have had and the doctor said to me that I should really be drinking more water. But the fact that I wasn't drinking enough water he said he would try cutting down the diuretic to just one tablet and I've been on one tablet ever since and that seems to be helping.

Diuretics, ACE inhibitors and the anti-arrhythmic drug amiodarone can affect kidney function. A man said his diuretic dose had subsequently been halved; a woman had been referred to a specialist for investigations. For more about reduced kidney function see 'Kidney health'.

Robert is married with adult children. He retired at age 53 from the Royal Navy after a long career, then spent 12 years as a civil servant before finally retiring. Ethnic background: White English.

Well, that [kidney problem] was only diagnosed two weeks ago through a recent blood test. And I, I have a blood test every year, but on this particular occasion he wanted me to have another one, because he’s been monitoring whatever it is in my blood. And he saw me two weeks ago after the blood test, he said, “Well, I’ve got to tell you that you’ve actually got….” And he explained to me about the fact that doctors never really took a lot of notice of that particular disease or condition, and you can’t do anything about it, it’s just something you’ve got to live with, but it’s got to be monitored. And he explained to me about all that and said, you know, “We are going to have to have regular blood and urine tests.” And, and I’ve had a urine test and I haven’t had the result yet, but I can go down the surgery and find out. And I know that if there was a problem he’d ask them to send for me to see him.

Many people had experienced a persistent dry cough when taking certain ACE inhibitors; one woman said that clopidogrelhad made her cough, although this is rare. Some said that their doctor had taken them off their ACE inhibitor and prescribed an alternative type of medicine (see also ‘Beta blockers, ACE inhibitor, diuretics and aldosterone antagonists’).

No I've always taken the medication the doctor has prescribed. I've tried it,I mean I had, initially he did us give us a tablet called ramipril and that one gave me an awful cough so he changed that you know, because I read up on these particular ones which some do you give a cough, a side effect of a cough which was pretty awful coughing all night long in bed and that all, my wife will tell you that, cough, cough, cough. So he changed that, and then he, there is certain ones that will give you that type of side effect so they have to adjust them like. No, mostly all the tablets or medication he's given me, the doctor, I try it yes certainly but if it doesn't work right I tell him [laughs].

view profile

Profile Info

Age at interview:

76

Sex:

Male

Age at diagnosis:

70

Background:

Retired company director, married. In his first marriage he had three children; two in their fifties and one is deceased. Ethnic background: British.

And he’s [GP] monitored very carefully how they’ve affected me. One example was ace inhibitors which I can’t exactly remember what they do but, one of the unfortunate side effects was coughing. Coughing like mad and he changed that prescription to an alternative, can’t remember what that’s called, or can I? Candisatin, yes candisatin which is an alternative to an ace inhibitor and that has certainly not caused any side effects. So he regularly checks on the medication and the side effects.

view profile

Profile Info

Age at interview:

73

Sex:

Female

Background:

Anne is married with adult children. She is a retired sick children’s nurse. Ethnic background: White British.

No problem with beta blockers but it’s the ACE inhibitors. They cause me to cough at night. So that was changed to an ARB, and I can’t remember what the initials stand for.

Angiotensin Resister Blocker, or something like that.

Blocker, yes, yes, yes. That’s right. And then I was put on to spironolactone or eplerenone and both of them gave me absolute disaster with my gut. I couldn’t go out anywhere without rushing to the loo and so I can’t take either of those drugs which are very useful for extending life apparently. So I don’t take those and I can’t take. When I was changed from the ACE inhibitor my consultant wanted me to take a particular dose of candesartan. So I started taking it and with the nurses I was increasing it and it just made me unbelievably breathless. I couldn’t walk half way down the garden. It was dreadful. So I, I said, ‘I’m not, I’m not going to stick with it. I can’t. It’s just awful’. So they put me on to losartan and I had the same effect, so I am on a tiny, tiny little dose of losartan, although I don’t think my consultant is very pleased with it , the nurses say, ‘Well, you know, everybody is different and that’s all you probably need.’ I’ve never had high blood pressure so, you know, it probably is all I need. So, but it keeps me well.

Side effects on the digestive system were also reported. These included indigestion, nausea, loss of appetite, taste changes, and constipation or diarrhoea. Many found it difficult to pinpoint the cause of some side effects like the loss of appetite; one woman found that the smell of food put her off eating though she still liked cooking. Another person found that he often hated food that he had liked before he was ill, which he blamed on all the drugs he was taking.

I can't, I can't make myself eat because I feel sick. I haven't had anything to eat at all today and I'll have a sandwich for my tea. Evening, a slice of toast maybe. But I can't, I'm not saying I can't, that's wrong. I might have a bacon sandwich occasionally but I can't eat meals, cooked meals, dinners, things like that. I have no appetite. I make, like my own pies and things like that, you know I don't buy pies, casseroles and stews, I make everything myself, but I just have no appetite. The smell of food, in fact, sometimes I could just run a mile. It's not, I don't think, I don't know what it is. I was talking to somebody at the hospital the other day, she said, well it was at the Warfarin clinic, and she said it was nothing to do with the Warfarin. I said 'I know because I was on that before'. So I don't know what it is.

view profile

Profile Info

Age at interview:

64

Sex:

Male

Age at diagnosis:

63

Background:

Retired sales manager; married with 2 children.

I'll give you another example if you like. From time to time I used to enjoy tinned salmon. I just liked it, it was lovely. And one day [wife] said 'how about some nice salmon from a tin, I got a tin specially in for you if you would like to try it?' I said, 'Yes, sure' because when you're looking after somebody who's not very well it's difficult to find things that they like and the first mouthful of this salmon was quite normal, very nice and I think well I'm going to enjoy this and the next mouthful was like metal polish. It was really disgusting and I couldn't eat it. A few months later we went to [a friends] and you can't be too choosy can you? And what did she give us but tinned salmon and on that occasion I thought it was lovely.

Oh, no doubt about it. It's absolutely down to the medication. I mean, if you think about what I said earlier about the quantity of drugs chucking it down in your tummy, it's not all at once, it's some in the early morning and then after breakfast and every meal I have to have Metformin which is to counteract sugar.